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4798 Auburn Way N Suite 106 Auburn, WA 98002(253) 236-5240

Sleep Solutions Northwest

Better Sleep for a Better Life

Our Practice
Sleep Apnea
TMD
- TMD Quiz
- Patient Forms – TMD
Referring Doctors
- How to Refer/Documents Needed
- Insurance Questions
Contact

SCHEDULE APPOINTMENT

Our Practice
Sleep Apnea
TMD
- TMD Quiz
- Patient Forms – TMD
Referring Doctors
- How to Refer/Documents Needed
- Insurance Questions
Contact

Sleep Quiz

TO FIND OUT IF ORAL APPLIANCES ARE AN OPTION FOR YOU, PLEASE COMPLETE THE QUIZ BELOW.

Were you ever diagnosed with Sleep Apnea?*
- Yes
- No
If you were diagnosed with sleep apnea, were you prescribed a CPAP?*
- Yes
- No
How many nights per week do you use your CPAP?*
- I don't wear it
- 1-3 nights
- 4-6 nights
- Every night
How many hours a night do you use your CPAP?*
- I don't wear it
- 1-3 hours
- 4-6 hours
- 7 or more hours
Do you use your CPAP while traveling, camping or boating?
- Yes
- No
What about your CPAP don’t you like?*
- Too much pressure
- Feel like I can't breath
- Uncomfortable
- Feel claustrophobic
- Too noisy
- Mask leaves marks
- Too hard to clean
- Other
If Other, please provide details
Would you like to schedule an appointment to discuss a CPAP-alternative treatment option?*
- Yes
- No
How did you hear about the TMD & Sleep Apnea Clinic?
If Other, please provide details
Name*
First Last
Email*
Phone*
Phone
This field is for validation purposes and should be left unchanged.

CONTACT OUR OFFICE

Call today!

Fax Number:

866-861-6286

4798 Auburn Way N Suite 106
Auburn, WA 98002
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OFFICE HOURS

MON	9:00 AM - 4:00 PM
TUES	9:00 AM - 4:00 PM
WED	9:00 AM - 4:00 PM
THURS	9:00 AM - 4:00 PM
FRI	9:00 AM - 4:00 PM
SAT	CLOSED
SUN	CLOSED

4798 Auburn Way N Suite 106 Auburn, WA 98002

SCHEDULE APPOINTMENT

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